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I came across this public service announcement from the AAOS (American Academy of Orthodpaedic Surgeons). It’s meant to be amusing but capture your attention on the dangers of being a “digital deadwalker”–you know the people who walk and talk (or text) on their cellphones–seemingly oblivious to the danger that imposes on them and others. It’s short and sweet video but hits the point home. Worth a chuckle but worthy of consideration too. Be careful out there. Stay engaged with your surroundings!

Can exercise be as effective as medication to treat people with heart disease, Type 2 diabetes, and stroke?

Researchers seem to think so.

In a study published in the British Journal of Medicine this past week, physical activity (including regular exercise) was deemed to be potentially as effective as many drug treatments.

Researchers form the London School of Economics, Harvard Medical School and Stanford University’s School of Medicine compared the effectiveness of exercise versus drug treatments on mortality rates across four health conditions by analyzing the results of over 300 randomized control trials involving over 300,000 individuals. For two of those conditions (secondary prevention* of coronary heart disease and prevention of diabetes), the researchers found no statistically detectable differences between exercise and medication.

*Secondary prevention refers to the treatment of patients who already have a disease but who have not yet developed any significant illness.

To set this in context, cardiovascular disease claims at least 17 million lives a year worldwide, making it the number one cause of premature death. In those cases where drug interventions provide only modest benefits, especially when compared to exercise, patients should be made aware of the relative impact of exercise vs. drug therapy, the researchers argue.

What about the other two conditions they examined? For stroke, the good news is that exercise was considered to be more effective than drug interventions. For heart failure, however, drug therapies (specifically the use of diuretics) were more effective than exercise.

The authors of the study did note, however, that there are many more trials into the effectiveness of drug therapies than there are for exercise studies, so this may have had an impact on the results. They argue that more trials comparing the effectiveness of exercise and drugs are urgently needed to help doctors and patients make the best treatment decisions. In the meantime, they say exercise “should be considered as a viable alternative to, or alongside, drug therapy”. And they call on regulators to consider requiring pharmaceutical sponsors of new drugs to include exercise in their trials as part of the control group.

What was not specified in the research was the type of exercise needed but based on previous studies, cardiovascular (or aerobic) exercise is considered to be the most beneficial for these types of conditions. This is reflected in Canada’s Physical Activity Guidelines, which state that at least 150 minutes of moderate-to-vigorous physical activity, in bouts of 10 minutes or more, are required per week to achieve health benefits with at least two sessions of muscle and bone strengthening exercises in addition.

In the UK, where the study was published, only 14% of adults exercise regularly and yet prescription drug use rates have ballooned in the last 10 years from an average of 11.2 prescriptions per person in 2000 to 17.7 prescriptions in 2010. Numbers are not much better in Canada, where only 15% of Canadians meeting the physical activity guidelines. As for prescription drug use in Canada, drug expenditures are growing faster than any other component of health care. If you include non-prescription drugs as well, Canadians spent over 30 billion dollars in 2010 or an average of $836 per person, second highest in the world, after the US, which spends $1,062 per capita.

Always discuss treatment options with your doctor. And be sure to let you doctor know if you exercise regulary. Your doctor needs to know this in order to prescribe what is best for you and you need to know all of your treatment options.

I recently attended the Research to Action conference hosted by the Canadian Centre for Activity and Aging at Western University in London, Ontario. Part of the CCAA’s mandate is to apply evidence-based principles of exercise research to group fitness classes for older adults. The conference was well attended, and as usual, there were plenty of opportunities to learn new “tricks of the trade” to enhance my own classes and to network with colleagues from around Canada.

One of the highlights of the conference each year is a synopsis of research findings in the area of physical activity and aging. Western University’s Dr. Liza Stathokostas presented a review of the top five research articles within the last year. The five she cited were:

1. Does stretching provide any significant health benefits?

After exhaustive scholarly reviews of the literature, Dr. Stathokostas concluded that there is no strong relationship between stretching and functional abilities which would allow us to provide recommendations on how long and how often to stretch. It is strongly advisable not to perform static (or held) stretching before a work-out but rather to do dynamic (or moving) stretching exercises help warm up the joints and prepare them for exercise. The scope of the scholarly review, however, was for guidelines in the general population and not therapeutic or rehab applications where certain types of stretching are known to be crucial in the healing process.

Based on a paper accepted but not yet published in the American Journal of Sports Medicine, older people in general were not necessarily more prone to injuries than younger people. Across all ages, males were more prone to injury from weight training and more often in weight training machines (vs. free weights). Four activities in particular had higher rates of injury in older people: golf, bowling, skiing, and cycling.

Reference: American Journal of Sports Medicine, accepted for publication May 2013.

3. What are the best exercise strategies for falls prevention in older adults?

When comparing various types of interventions to prevent falls, such as Tai Chi, in-home assessments, education, gait and balance training, strength training classes, and multiple component classes or home-based programs, Tai Chi was found to be the most effective in reducing the risk of falling, whereas multiple component classes and home-based programs were the most effective in reducing the rate of falls.

Across multiple studies, there was strong evidence for improvement when there was increased physical activity (equivalent to 30 minutes of moderate activity most days of the week). In fact the evidence supported aerobic activity over resistance training, although both were found to be effective.

This area of research has garnered much attention over the years and now there is strong evidence to support limiting the time spent sitting. Stathokostas and Dogra’s research showed that middle aged and older adults who were the least sedentary (< 2 hours/day) were 43% more likely to age successfully compared to those who were sedentary for 4 or more hours per day.

All and all, the various workshops and presentations provided a wealth of information to fitness professionals like me. I am looking forward to next year’s Research to Action conference!

Another Canadian University that regularly contributes to research in the field of physical activity and aging is the University of British Columbia in Vancouver. A study, published in May in the on-line journal PLoS ONE looked at 86 women aged 70 to 80 who had some form of mild cognitive impairment. For six months, researchers studied the participants, who were grouped into various types of exercise regimens from weight training classes, outdoor walking classes, and balance and tone classes. The purpose of the study was to see if the participants would make fewer trips to the doctor and require fewer diagnostic and other health-related services. Specifically, the researchers were interested in which types of exercise classes were most effective in lowering health-care usage.

At the end of the 6-month study, the researchers concluded that those in the resistance training and aerobic training groups had significantly improved cognitive function and incurred lower health-care usage costs than those who participated in balance and toning classes.

A client of mine passed along a link to a regular column on exercise in the New York Times. It’s a Q&A page and the author of the blog, Gretchen Reynolds, gives, from what I’ve read so far, balanced and knowledgeable answers. She does a good job of condensing the research into practical and meaningful advice to her readers. So, I thought I’d point you to her column and then I would tackle one of the questions she addressed and offer anything else I feel could be of help. So, let’s take a look at a condition one of Gretchen’s readers asked about–plantar fasciitis and what self treatment could be done to help heal it. To read the full question and answer, see the following: How can I facilitate healing my plantar fasciitis? According to the doctor she interviewed for the article, self-care involved doing a calf stretch at the wall 20 times per leg and holding each stretch 10 seconds.

I would like to add to that a course of treatment advocated by a physiotherapist and author of “The 5-Minute Plantar Fasciitis Solution”, Jim Johnson. He cites a number of studies into various types of stretching, sometimes in conjunction with other modalities such as anti-inflammatory drugs like Ibuprophen. The treatment he prescribes is a specific type of stretching involving pulling back on the toes of the affected foot while that foot is crossed over your other thigh. The stretch is held for 10 seconds and repeated 10 times. The whole sequence is performed at least 3 times a day (10X10X3 = 300 seconds or 5 minutes). Personally, I can vouch for the effectiveness of this stretch! But please see his book for the full details.

Calf stretches were shown to be more effective in keeping plantar fasciitis from returning rather than treating it specifically, according to the studies he cites. This classic stretch involves placing one foot forward on the floor, toes touching the wall, and the other leg well back and kept straight. With the hands on the wall, lean in to the ball by bending the front knee. Hold for 20 seconds per leg and do at least 3 times per day. Repeat 3 days/week on alternate days.

The one pattern I noticed for all of the stretches suggested in the studies I’ve looked at were that the most effective stretches were held for several seconds (15-20 or performed multiple times if held for less time) and they were repeated several times a day and several days a week. Clearly the body likes to “bounce back” to it’s familiar state and so not giving it too much time in between treatments to do so is what is required. Unfortunately that familiar state is not always the most comfortable!

As with any health and fitness advice column, I recommend that you see a doctor or other qualified health care provider to get a proper diagnosis first before beginning self-treatment. Depending on the condition, that treatment may be quite different. What we often call an “-itis” may really be an “-osis” or the other way around. Is the condition acute (a sudden traumatic event or injury and the first few days following), chronic (long-term with or without a known specfic cause or trauma), or sub-acute (a condition that resulted from a traumatic event lasting from several days to a few weeks)? Other times we assume something is a tear when it really is “wear and tear”. Sometimes we try to diagnose ourselves because we know someone else who had the same condition. But was it really the same condition or did our friend’s perception of his/her symptoms just sound the same as ours. Those are two very different questions.

So, my advice is to get the information you need to make an informed decision. You may be afraid to see a physician, physiotherapist, or other health-care provider because you’re afraid that you may have to take medication or go for therapy, and that may consume too much of your time, money, or your quality of life. But having a firm diagnosis does not necessarily mean that you need costly treatment or medication. Many ailments like plantar fasciitis can be treated for free because you’re the one doing the work. You may have somewhat better outcomes with an expensive therapeutic device such as laser or shock wave therapy but often these modalities provide the same outcome as self-care, although they may hasten or enhance the healing process. How they will help and if they will help your condition depends on what your condition is. Sometimes, you just need to take more time and be more patient with self-care. But if you are limited by time or money or both and do not want to take medications, self-care such as a program of specific stretching tailored to your condition is often all you need, although heat or ice where and when appropriate may also be required. Again, none of these treatments cost anything, although they do require some of your spare time. However, sitting home doing a few minutes of stretching is not exactly wasting time compared to time lost travelling for professional treatment.

Conditions such as plantar fasciitis often recur because of imbalances or weaknesses in the underlying structures (the bones and joints themselves) or by improper movement patterns, which, unfortunately are exacerbated by the aging process. And so it is imperative that you have a self-care treatment plan in your tool kit. The type of stretching you choose, whether you use ice, heat, or both, or neither, lifestyle changes you may make, and other things you can do for yourself will depend on the specific condition you have. Get a proper diagnosis and once you do have one, remember that you have options!

Once in a while I read a feel-good story which I then like to pass on to my readers. This is a story from The Washington Post, link below. Thought you might enjoy hearing about a 102 year-old gentleman who only started working out a few years ago! He was physically active during his working life but over the years and especially after the loss of loved ones and loss of responsiblity, he felt he was getting lazy and decided to “take it up a notch”. He is a real inspiration on how important it is to be physically active or exercise regularly throughout the lifespan!

We hear more and more about the dangers of sedentary living, and sitting too long in particular. Studies have linked sitting and sedentary lifestyles to a whole host of ailments, including higher risk of Type II Diabetes and shorter life expectancy. The longer we sit, the less our muscles move, and the less fuel they require. But we keep feeding them just the same, so that excess fuel (sugar) gets stored in our bloodstream instead of being burned for fuel. Thus the link to diabetes and other health concerns that come with excess blood sugar and obesity.

But did you know that even if you exercise every day but the rest of your day is primarily sedentary, you can still suffer from many of the same ailments — in other words, thirty minutes to an hour a day of exercise does not undo the damage done by being inactive the rest of the time you are awake.

So, how did we get to be a culture that sits or is sedentary most of our day? One might argue that we have no choice when we work in an office all day and have to commute, but I believe it’s the subtle changes that have occurred over the last thirty years that have made the problem worse.

Our commutes are longer — up to twice as long as even ten years ago in many North American cities. In fact, my home city of Toronto has one of the longest average commute times in North America.

We’ve replaced a lot of our TV watching time with “on-line” watching time. Twenty-five years ago, most of us who used a computer did so only at work. Other than for playing PacMan, not many of us used a computer at home. And if we did, we might have spent a few minutes working on the family budget. Most of us were not “on-line”, so sitting time at home was primarily for watching TV or reading a good book. When we did sit and watch TV, we had to get up to change the channel, turn up the volume, or fix the “vertical hold” (remember those days?). And, most of us went to bed after the nightly news ended. Today, apart from watching television, people sit in front of their computers for hours emailing, being on Facebook or Twitter, even bringing their laptops and tablets to bed. On average, North Americans are sleeping one hour less per night. That extra hour is not spent being phsyically active but instead is spent sitting or being sedentary.

Even at the office, we are moving far less than we did a generation ago. Emailing colleagues down the hall is not uncommon. Let’s face it, it gives us a “paper trail” but as a result, instead of getting up and going down the hall to talk to a colleague, we sit and do it all without having to leave our desk.

Most of us are working longer hours too. The average office worker in North America is working a longer day since the 2008 recession. So, even though the work day had been shorter than it was a century ago, it is steadily creeping back up. The difference is that a century ago, we did not have the labour saving technology we do today, so people were more physically active…by necessity.

And this spills into our meal times too. More and more we are relying on convenience foods for our dinners because we are so tired at the end of a long day at work, that we would rather open up a package of food instead of making it from scratch. Go into any supermarket these days and there are whole aisles of prepared meals waiting to be picked up, taken home, heated, and served. Voilá! The act of cutting up vegetables and preparing dinner while standing (remember stirring a pot?) has been replaced by heat, serve, and eat.

So, when you add it all up, we are sitting for longer periods of time. Coupled with serving sizes which have nearly doubled in the last twenty-five years, we are quite simply eating more and moving less.

What we really should be doing is eating less and moving more!

So, what to do? It’s still early — make 2013 your year to do just that — eat less, move more!!

How to do it? I wish I could wave a magic wand and make your commute shorter or subtract an hour from your long day at the office but I can’t. However, I can offer some suggestions to help you eat less and move more.

1. If you must send an email to a nearby colleague, do so but get up from your seat and hand-deliver it to them. Even better, save a tree and don’t print it. Send it and make a point of still going to visit the colleague and asking if they require anything more or need clarification. Or just tell them that you’re looking for an excuse to get up an “stretch your legs”. You might even inspire them to do the same.

2. Stand up for part of your work day. Do you need to sit and take that phone call? Do you need to sit through all of the meeting? Could you convince your colleagues to stand for part of it? If it’s your meeting, you make the call!

3. Walk up stairs instead of taking the elevator as much as possible. If you work on the 25th floor, if possible get off the elevator at the 23rd or 24th and walk the rest (assuming you don’t set off any alarms!).

4. Walk on your lunch hour.

5. If you go out for lunch with friends and colleagues, how about splitting an entree or skipping dessert? We managed on fewer calories in the past quite fine, when the obesity rate was much lower (and coincidentally we moved more) so we can do it again!

6. If you need to run errands after work, look for a parking space far from the store entrance. You avoid all the headache of jostling for the same spot that everyone else is, and you’ll get a few steps in.

7. Rely less on processed food even if you’re on a time crunch. Processed foods are packed with extra sugar, salt, and refined flour, which pack on the pounds with extra calories, require fewer calories to be digested, and spike your blood sugar. Convenience does not have to mean processed! If you have to “pick something up” for dinner, how about making the prepared food only a part of your meal? Buy some raw veggies or salad greens and prepare them yourself as a side dish. Not only do they provide good fibre to your diet but you’ll need to stand a little longer at the counter before you plunk yourself down at the kitchen table or in front of the TV.

8. Don’t forget to exercise! Those thirty minutes to an hour of moderate-to-vigorous physical activity per day are still crucial to your health. It works hand-in-hand with cutting down on the time you spend sitting. Make sure your exercise regimen includes both muscle building AND aerobic (cardio or endurance) activites — and don’t forget to stretch!

9. Whether sitting at the office or at home, get up and move at least every hour. It doesn’t mean you have to walk around a lot (although that’s not a bad idea). At a minimum, just stand up, even if only for a few seconds. It will give those muscles that you’ve been sitting on and holding in a flexed position a break. They will get stretched just by standing up!

10. Be aware of the time you spend on the computer at home and ask yourself, “how much of this time is quality time?” Do I really need to post ten cute kitten photos every day on Facebook? Quality over quantity is a good rule to follow.

So, it’s a new year! How about making a resolution that you can keep quite easily — make it your year to be “on the move”!

The annual Canadian Cardiovascular Congress took place between October 26 and 31 in Toronto this year. The Toronto Star covered the conference and a number of interesting findings appeared in press releases this past week.

Especially worth a read are how three prominent cardiologists keep their own hearts healthy.

A colleague of mine sent me a link to a video of a gentleman in his early 70s who, some might say, has never grown up. Besides putting a smile on your face, you will also be amazed at the agility, coordination, and balance of this man. I don’t avise doing some of these stunts at home, folks, but after you’ve watched him you may just want to take up juggling at least. He’s right about the connection between having an active body and an active mind–there’s plenty of research to back that up–and he truly is an inspiration for those of us who want to keep moving at any age. Hope you enjoy. Here’s hoping we…

Last Wednesday The Lancet medical journal reported on the findings of researchers who studied instances of falls in elderly people residing in 2 BC long-term care (LTC) facilities. Videos were captured of 130 residents who had fallen to determine the circumstances around the fall. Of the 227 falls captured on video, 41% were the result of improper weight shifting. The rest of the falls were attributed to stumbling or tripping (21%), bumping into objects, losing support, and collapsing all tied at 11%, and 3% were a result of slipping. Surprisingly, more falls were a result of weight transference than what was assumed. Weight tranference is when the centre of mass is taken outside the base of support. When we are standing still, our centre of mass is directly over our base of support. When there is a disturbence in which the centre of mass oves moves outside the base of support, balance is challenged and if balance is lost, a fall can occur. The researches concluded that by knowing better the circumstances around falls, balance and falls prevention programs can become more targeted and effective.

To your health!

Chris

References

Robinovitch, S. , Feldman, F., and Yang, Y. (2012). Video captre of the circumstances of falls in elderly people residing in long-term care: an observational study, The Lancet, Early Online Publication, 17 October 2012.

The belief that more weight built more muscle than more repetitions did is being given a second consideration–at least in older men.

Researchers studied 2 groups of 6 young men (avg age 24) and 2 groups of 6 older men (avg age 70) who followed one of two exercise programs. Half of the young and half of the older participants performed knee extensions using 3 sets of 14 repetitions then 6 sets of 14 repetitions at lower weight while the other half performed the same exercise using 3 sets of 8 repetitions then 6 sets of 8 repetitions at a higher weight. The total muscle exertion was the same regardless of the number of sets and reps because when the weight was lower, the volume (sets and reps) was higher and vice versa. Biopsies were taken of the participants’ leg muscles to look for the amount of protein synthesis (which occurs when muscle is being repaired and rebuilt after a work-out). In the two groups of young men, the amount of muscle growth was not significantly increased when higher repetions or sets were involved, i.e. the higher weight played more of a role than the number of sets/reps. This was not the case for the older men. For those two groups, increasing the number of reps had a greater effect on protein synthesis even when the weight was low. From a safety standpoint, it is often recommended that older people benefit from lower weight and higher reps but now it may also be the case for muscle growth as well.